Laboratory diagnosis of Neisseria gonorrhoeae in St Petersburg, Russia: inventory, performance characteristics and recommended optimisations

Abstract

Objectives: To perform a comprehensive inventory of the number of samples, performance characteristics, and quality assurance of the laboratory diagnosis of Neisseria gonorrhoeae at five laboratories in St Petersburg and Leningradskaya Oblast, Russia, in 2004, and to recommend optimisations for an increased adherence to international evidence based recommendations of diagnostics. Methods: Surveillance data were obtained with questionnaire and site visits. For evaluation of the culture media utilised at the laboratories, N gonorrhoeae reference strains (n = 29) were used. Results: During 2004 the total numbers of N gonorrhoeae samples analysed at the five laboratories using microscopy of stained smears and culturing were 330 879 (407 positive) and 38 020 (420 positive), respectively. Four laboratories used a Russian non-selective culture medium-that is, Complegon, and one laboratory utilised Biocult-GC. Both media seemed suboptimal. Only two of the laboratories used any species confirmative assay. Antibiotic susceptibility testing of N gonorrhoeae was performed at only two of the laboratories and each year only occasional isolates were analysed. None of the laboratories comprised a complete laboratory quality assurance system. Conclusions: According to international recommendations, the diagnosis of N gonorrhoeae in St Petersburg and Leningradskaya Oblast, Russia, is suboptimal. More samples need to be analysed by culturing on a highly nutritious and selective medium and, furthermore, species confirmation and antibiotic susceptibility testing should be more frequently performed. In addition, the utilised methods for culturing and antibiotic susceptibility testing, including medium and interpretative criteria used, ought to be optimised, standardised, and quality assured using systematic internal and external quality controls.

National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005-2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia

“…Previously, thorough knowledge regarding these issues has been entirely lacking and very limited studies have been performed 15 – 18. This has been mainly the result of suboptimal diagnostics, including the rare use of culture and a lack of antimicrobial susceptibility testing for N gonorrhoeae 17 22 – 24. The present national surveillance programme has, however, recently implemented appropriate, standardised and quality assured culture diagnostics, as well as effective and quality assured antimicrobial susceptibility testing, in accordance with international recommendations21 25 – 29 in Russia.…”

Laboratory Diagnosis of Sexually Transmitted Infections in Belarus

“…Many tests used in STI diagnostics in Belarus are manufactured in Russia. Clinical evaluation of these tests should prove valuable when choosing the most appropriate test systems for use in Belarus (7)(8)(9)(10).…”

Antibiotic susceptibility of Neisseriagonorrhoeae in Arkhangelsk, Russia

“…Consequently, it is crucial to optimise the diagnostics of N gonorrhoeae in accordance with international recommendations 10 -that is, to introduce a quality-assured selective culture medium, thorough species confirmation, as well as optimised and quality-assured antibiotic susceptibility testing, in Arkhangelsk as well as in many other Russian areas. 1 In addition, establishment of local, regional and national surveillance of the antibiotic susceptibility of N gonorrhoeae is urgently needed in Russia.…”

“…Regarding the incidence of gonorrhoea, reliable figures are still lacking mainly because of suboptimal diagnostics, incomplete epidemiological surveillance and reporting of new cases, as well as self-medication. 1 Furthermore, the prevalence of antibiotic resistance of Neisseria gonorrhoeae is unknown in most Russian areas, and this knowledge is crucial for empirical treatment. Owing to the worldwide rapid increase of antibiotic resistance, empirical treatment strategies need constant re-evaluation, 2 and antibiotic susceptibility testing is the main tool for updating them.…”